Diabetic Retinopathy

By Kenneth N. Darvin, M.D.

According to the U.S. Centers for Disease Control and Prevention, over the past decade there has been a forty-percent increase in the percentage of the U.S. population with diabetes.More than sixteen million Americans are living with diabetes and the risk of developing serious complications. A third of those who have diabetes do not even know it.

There are two main types of diabetes, type I and type II. People who have type I have lost the ability to produce insulin, the hormone that regulates the level of glucose in the blood. Approximately five to ten percent of the sixteen million diabetics in the U.S. are type I.

Type II diabetes most often occurs in adults. This type of diabetes accounts for ninety percent of cases in the U.S. and is often associated with obesity. People with type II diabetes have insulin, but their body is resistant to it.

Anyone can get diabetes; some people are at higher risk. These include people who have relatives with diabetes, people who are overweight, African Americans, Hispanics, Native Americans, the elderly, Asian Americans and those who had gestational diabetes. It is estimated that five million people in the U.S. have diabetes and do not know it. People do not realize it because the symptoms develop gradually, or in some cases without any symptoms at all. Some of the symptoms are: increased thirst, frequent urination, unexplained weight loss, increased hunger, blurry vision, recurring skin infections, wounds that do not heal, and unexplained fatigue.

More than eighty percent of patients with type II diabetes are overweight, often associated with fat in the abdominal area. With these patients exercise and weight loss is important in the treatment regimen, in combination with oral medication that makes the body's tissues more responsive to the insulin that is present.

With type I diabetes, treatment consists of administration of insulin and dietary changes. There is very exciting ongoing research involving islet cell transplant. These are the cells that produce insulin. There is also research involving stem cells here and abroad.

People with diabetes must monitor their glucose for both long and short-term complications. Near term complications can lead to dehydration, coma and even death. Long term complications cause changes in the blood vessels of the body, leading to strokes, heart disease, blindness, kidney failure, nerve damage and impotence. People with diabetes can lower their risk for these complications by keeping their glucose levels as close to normal as possible.

One can have impaired glucose tolerance. This means that one's glucose is higher than normal, but not high enough for the diagnosis of diabetes. These people are at increased risk for developing type II diabetes. About twenty million people have impaired glucose tolerance and ten percent will go on to develop diabetes.